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Surgery Shelf > Trauma > Flashcards

Trauma Flashcards

0
Q

Causes of shock

A

Bleeding (hypovolemic hemorrhagic)-CVP low, empty veins
pericardial tamponade- CVP high, distended veins, trauma, no respiratory distress
Tension pneumothorax- CVP high, distended veins, trauma, respiratory distress, unilateral no breath sounds, hyperresonance, tracheal displacement.

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1
Q

Clinical signs of shock

A 
Low BP (<0.5mL/kg/h
Cold, shivering, sweating, thirsty, and apprehensive
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2
Q

Treatment of hemorrhagic shock

A

Volume replacement-2L LR w/ packed RBCs until 0.5 UOP

Surgery to stop bleeding

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3
Q

Management of pericardial tamponade

A

Clinical dx confirm with u/s

Pericardialcentesis, tube, pericardial window, or thoracotomy

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4
Q

Management of tension pneumothorax

A

Clinical dx
Catheter into affected pleural space
Follow with chest tube connected to underwater seal

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5
Q

Other causes of hypovolemic shock

A

Burns
Peritonitis
Pancreatitis
Massive diarrhea

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6
Q

Intrinsic cardiogenic shock

A

Caused by massive myocardial damage- MI or myocarditis
Tx with circulatory support
NO fluids

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7
Q

Vasomotor shock

A

Anaphylactic rxn or high spinal transection
Circulatory collapse in pink warm patient
CVP low
Restore peripheral resistance

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8
Q

Linear skull fracture

A

Left alone if closed
Open req closure
Comminuted or depressed go to OR

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9
Q

Head trauma w/LOC

A

Always get CT looking for intracranial hematoma

If negative can go home with wakings

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10
Q

Basilar skull fracture

A 
Raccoon eyes
Rhinorrhea
Otorrhea
Ecchymosis behind ears 
Assess integrity if C spine w/ CT
nasal endotracheal intubation AVOIDED
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11
Q

Neurological damage from trauma

A

Initial blow
Hematoma- displace structures
Increased ICP

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12
Q

Acute epidural hematoma

A

Trauma, LOC, lucid interval, gradual lapse into coma
Fixed dilated pupil, contra lateral hemiparesis, decerebrate
CT shows biconvex lens shaped hematoma
Tx emergency craniotomy

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13
Q

Acute subdural hematoma

A

Same but worse trauma and more severe damage
Not fully awake or asymptomatic at any point
CT shows semilunar crescent shaped hematoma
If midline shift, can craniotomy but bad prognosis
Prevent ICP increase: monitoring, elevate HOB, hyperventilate to pCO2 35, avoid fluid overload, mannitol, furosemide
Sedation to decrease brain activity
Hypothermia to reduce oxygen demand

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14
Q

Diffuse axial injury

A

Severe trauma
Cat shows diffuse blurring of gray-white interface and multiple small punctuate hemorrhages
Without hematoma no surgery
Prevent increased ICP

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15
Q

Chronic subdural hematoma

A

Occurs in very old or severe alcoholics
Shrunken brain rattles around tearing venous sinus
Over days/weeks mental fxn declines
CT dx and surgical evacuation tx

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16
Q

Hypovolemic shock and intracranial bleed

A

CANNOT HAPPEN

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17
Q

Penetrating neck trauma

A

Surgical exploration if hematoma, deteriorating vital signs or esophageal/tracheal injury
Explore GSW of middle zine

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18
Q

Selective neck trauma approach

A

GSW upper zone: arteriography

GSW base of neck: arteriography, water soluble esophagogram, esophagoscopy, and bronchoscope

19
Q

Neck stab wounds

A

Upper and middle zones observed

20
Q

Severe blunt trauma to neck

A

C spine eval

CT best

21
Q

Hemisection, brown sequard

A

Clean cut injury
Paralysis and loss of proprioception distal to injury ipsilaterally
Loss of pain perception contralateral

22
Q

Anterior cord syndrome

A

Seen with burst fracture of vertebrae
Loss of motor fxn, pain, and temperature bilaterally
Preserves vibratory and positional sense

23
Q

Central cord syndrome

A

Elderly with forced hyperextension of neck- rear ended

Paralysis and burning pain upper extremities

24
Q

Rib fracture

A

Can be deadly in elderly
Pain->atelectasis->pneumonia
Tx w/ nerve block and epidural catheter

25
Q

Pneumothorax

A

Penetrating trauma or rib fx stab
SOB, unilateral loss of breath sounds, hyperresonance
Get CXR then place chest tube

26
Q

Hemothorax

A

Penetrating wound or rib fx
Dull to percussion
CXR
Evacuate with chest tube to prevent empyema
Thorocotomy if systemic vessel bleed
Surgery if >1500ml in chest tube on insertion, or >600ml over 6 h

27
Q

Severe blunt chest trauma

A

Hidden injuries
Monitor blood gas and CXR for pulmonary contusion
Cardiac enzymes and EKG for myocardial contusion
Always look for traumatic aortic transection

28
Q

Sucking chest wound

A

Flap sucks air
Lead to tension pneumothorax
Tx occlusive dressing

29
Q

Flail chest

A

Multiple rib fx allows wall segment to cave in and bulge out
Underlying pulmonary contusion
Contusion sensitive to fluids so restriction and diuresis
Monitor blood gas
If ventilated, need bilateral chest tubes
R/o aortic transection

30
Q

Pulmonary contusion

A

Deteriorating blood gasses and white out of lungs on CXR
can appear early or late
Tx fluid restriction and diuresis

31
Q

Myocardial contusion

A

Suspected in stern all fx
EKG detects and cardiac enzymes
Tx complications like arrhythmia

32
Q

Traumatic rupture of diaphragm

A

Bowel in chest on exam and CXR
Always on left side
Eval with laparoscopy with surgical repair

33
Q

Traumatic rupture if aorta

A

Occurs at junction of arch and descending
Deceleration injury
Asymptomatic until hematoma I’m adventitia blows up and kills
Always suspicious esp if broken 1st rib, scapula or sternum; wide mediastinum
Transesophageal echo, spiral CT, MRI angio

34
Q

Traumatic rupture of trachea or bronchus

A

Subcutaneous emphysema in upper chest, lower neck, or air leak
CXR shows air in tissue, bronchoscope shows lesion and allows intubation beyond lesion
Surgical repair

35
Q

Air embolism

A

Sudden death in chest trauma intubated on respirator
Also when subclavian vein open to air
Tx: cardiac massage w/ pt LT side down
Prevent w/ trendelenburg when entering great vessels

36
Q

Fat embolism

A

Respiratory distress
Multiple fx including long bones
Petechial rash in axilla and neck, fever, tachycardia, low platelets
Tx w/ respiratory support

37
Q

GSW to abdomen

A

Exploratory laparotomy

Enter or exit below nipple assumed abdominal

38
Q

Abdominal stab wound

A

If clear penetration, unstable vitals, or peritoneal irritation then laparotomy
Otherwise digital exploration of wound

39
Q

Blunt trauma to abdomen

A

ExLap if signs of peritoneal irritation
Otherwise determine if bleeding
Look for signs of internal bleeding

40
Q

Signs of internal bleeding in blunt trauma patient

A

Drop on BP w fast threads pulse, low CVP, and low, UOP
Signs of shock when loss 25-30% blood volume
Can be into pericardial sac, pleural cavity, abdomen, thighs and pelvis

41
Q

Diagnosis of intraabdominal bleeding

A

CT scan only if hemodynamically stable
Response to fluid resuscitation determines surgery
If unstable, diagnostic peritoneal lavage or FAST

42
Q

Ruptured Spleen

A

Most common significant intraabdominal bleed in blunt trauma
Hints: fx LT rib
Every effort made to salvage
If removed, vaccinate pneumococcus, H. Influenza, and meningococcus

43
Q

Intraoperative coagulopathy

A

Long abdominal surgery for multi trauma and lots of transfusions
Tx w/ platelet packs and FFP 10 units each
If also hypothermia and acidosis then stop lap and temporary close until correct issues

44
Q

Abdominal compartment syndrome

A

Lots of fluids/blood in long laparotomy
Tissues swollen and closure without tension impossible
Temporary cover over contents then close later
If you close anyway, get distention, retention sutures cutting thru tissue, hypoxia b/c can’t breathe and renal failure from vena cava compression
Then abdomen must be opened and put temporary cover

Surgery Shelf (8 decks)

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